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General NPI Number Information
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NPI Number | 1053512665
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Entity Type | Individual
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Provider Name | WENDY MIDGLEY PA
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 10462 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8501
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Country | US
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Telephone | 801-352-9500
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Fax | 801-352-9502
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Provider Business Mailing Address
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Address Line | 2678 EDGEHILL DR
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4330
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Country | US
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Telephone | 801-808-2970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 6324228-4810
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6324228-1206
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 6324228-126PA
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License Number State | UT
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